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General NPI Number Information
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NPI Number | 1750166815
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS OF BIXBY, LLC
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 13000 S MEMORIAL DR
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City | BIXBY
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State | OK
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Zip | 74008-2523
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Country | US
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Telephone | 918-369-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 S MEMORIAL DR
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City | BIXBY
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State | OK
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Zip | 74008-2523
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Country | US
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Telephone | 918-369-1202
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOREN MICHAELSEN
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Credential | DDS
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Telephone | 405-593-9596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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